“I’m here because my doctor insisted, but I don’t find these mindfulness practices helpful. When I practice with the group I can handle it, but when I do the meditations at home, my anxiety gets worse.” Lluis, (name changed for anonymity), was a participant of mine in one of the eight-week mindfulness-based programs I used to facilitate as a mental health nurse.

The programs were held at the adult mental health center of the Barcelona Hospital Clinic. At the time, we gave him some strategies to cope with the discomfort and he finished the program. Yet Lluis still felt that mindfulness wasn’t for him.

Mindfulness-based interventions (MBI) are very popular in Western countries and mindfulness is often praised as a “one size fits all” solution and that it works for everyone. While its benefits are supported, we also should be aware of its potential adverse effects.

We reached out to Ausiàs Cebolla, mindfulness and meditation researcher and assistant professor in the Faculty of Psychology at the University of Valencia, Spain. In 2017, Cebolla published one of the first studies exploring the presence of unwanted effects of meditation in a large sample of practitioners.

Cebolla explains that anyone who has practiced meditation regularly knows that there can be adverse effects associated with it. In fact, contemplative traditions have developed authentic treatises explaining these phenomena. Yet this has hardly been investigated in Western secular versions of meditation, as is the case with MBI.

A 2018 systematic review found that only 22% of randomized control trials (RCT) on mindfulness-based intervention considered the presence of adverse effects. Despite this, Cebolla noticed that there was an interest in the scientific community to understand these phenomena and as soon the research began, many fellow researchers wanted to get involved with the project. Among these groups Cebolla highlights the work done by neuroscientist Willoughby Britton and colleagues.

Britton and her team noticed that researchers were using different definitions and ways of measuring the adverse effects of meditation. How could we understand the phenomena if everybody was looking at the effects differently?

To solve this problem, Britton’s team, based on the World International Classification for Patient Safety and the CONSORT guideline, proposed a specific definition for adverse effects of meditation as any unintended effects of meditation that were experienced as negative or that had a negative impact on the person’s life. Britton’s team also developed a specific assessment tool to evaluate adverse effects of meditation, which is now widely used in mindfulness-based intervention studies.

Like so, Briton found that around 58% of participants in a mindfulness-based program encountered at least one negative experience during the meditation practice and 37% reported that meditation had a negative impact on their daily life. The most common adverse effects found were anxiety, time-space distortions, and traumatic re-experiencing.

Cebolla adds that there are risk factors that may contribute to the concern. For example, people who suffer from mental health disorders may be at a higher risk for experiencing unpleasant meditation-related effects. Other circumstances that may lead to experiencing difficulties with mediation include going to a meditation retreat without prior experience or the use of meditation without a good guide. Cebolla notes that professional training is a challenge. Mindfulness teachers should have adequate training, not only in meditation but also in mental-health disorders and crisis management.

Cebolla also highlights that it’s also important to inform people that they may experience some kind of transient pain and provide them with strategies to cope with these experiences.

Another possible concern is that we may be rushing into implementing meditation programs in the community without having a full understanding of their consequences or without taking into consideration safety measures. A recent qualitative study aimed to understand the non-positive experiences of students in a popular mindfulness-informed school-based intervention concluded that mindfulness teachers didn’t have the time and in some cases the knowledge to detect or manage discomfort.

Cebolla points out that before beginning a meditation practice it is important to choose the teaching context that best fits our goals: the psychoeducational, the clinical or the spiritual. Once we have made that choice it’s time to look for a good teacher, or an evidence-based protocol guided by an instructor with formal training. It’s important not to rush the practice and consolidate progress little by little. Finally, for people with psychological vulnerabilities, having external assistance from an expert who can guide the person through the practice.

-Maria Auxiliadora Sanchez Ledesma, Contributing Writer

Image Credits:
Feature: Brett Jordan at Unsplash, Creative Commons
First: Taylor Deas-Melesh at Unsplash, Creative Commons
Second: Art4Good at Wikimedia Commons, Creative Commons